BILL MOYERS: Make me an offer I can't refuse. That's what President Obama said, when he talks about health care reform during his State of the Union last week.

PRESIDENT OBAMA: If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors and stop insurance company abuses, let me know. Let me know. Let me know. I'm eager to see it.

BILL MOYERS: Dr. Margaret Flowers took him at his word.

MALE VOICE: Can I help you?

DR. MARGARET FLOWERS: Well, last night the President gave his State of the Union address, and I'm a physician. I'm the Congressional Fellow with Physicians for National Health Program.

BILL MOYERS: The very next day she was outside the White House with a letter urging the President to revive the idea of single-payer healthcare. Medicare for all.

MALE VOICE: We can't accept anything, so you'll have to send it through the mail.

BILL MOYERS: The Secret Service turned Dr. Flowers away, but she didn't give up. She tried again the next day in Baltimore, where once again, President Obama made his offer to hear ideas on health reform and once again, she tried to deliver her letter.

DR. MARGARET FLOWERS: Is there somebody here who's in charge that can have somebody who's a representative of the President, come and take this?

BILL MOYERS: This time, she and her colleague, Dr. Carol Paris, refused to move when security told them to, because Dr. Flowers said, "We didn't want to continue to be excluded, marginalized and ignored."

They were arrested.

DR. MARGARET FLOWERS: And we haven't been heard. They continue to exclude us.

BILL MOYERS: When I saw pictures of Margaret Flowers being led away, I remembered those famous words attributed to another Margaret, the anthropologist Margaret Mead who said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Dr. Flowers is with me now. A pediatrician from Maryland who worked at a rural hospital and in private practice, her full-time job is now the fight for single payer health insurance. She works on Capitol Hill for the organization, Physicians for a National Health Program. Welcome to the Journal.

DR. MARGARET FLOWERS: Thank you for having me.

BILL MOYERS: When you were arrested last Friday, were you taken to police headquarters?

DR. MARGARET FLOWERS: I was, with Dr. Paris.

BILL MOYERS: Were you handcuffed?

DR. MARGARET FLOWERS: We were.

BILL MOYERS: Were you interviewed independently by the Secret Service?

DR. MARGARET FLOWERS: Yes.

BILL MOYERS: What did they want to know?

DR. MARGARET FLOWERS: They wanted to make sure that we didn't have a psychiatric history or did we wish the President any ill harm.

BILL MOYERS: What did you tell?

DR. MARGARET FLOWERS: That no, we don't wish him any harm. In fact, if we passed a Medicare for all system, it would be a huge win, not just for the American people but for this administration. And that, in fact, we didn't really want to have to go through this to have our voices heard. We'd much rather be working with Congress and the administration.

BILL MOYERS: I was watching that tape of your arrest. And I think I heard you say, you know, "Would you please-" to somebody. "Would you please call my husband?" Is it true he didn't know you were out there and were going to get arrested?

DR. MARGARET FLOWERS: It's true. Yeah.

BILL MOYERS: What did he think when he found out? Did somebody call him?

DR. MARGARET FLOWERS: Actually, his brother called him because he saw it on the news. And he said, "Do you know where your wife is right now?" And my husband said, "No." Well, we weren't sure. Dr. Paris and I weren't sure what was going to happen that morning. We just knew that we would go down there with our banner and our letter and that hopefully, we could get our message across and that hopefully they would call a staffer to take our letter. And there came a point, though, when they kept saying, you know, "Go across the street and no, we're not going to call anybody," that we looked at each other. And without speaking, we both knew that, no, this is too important. We're not going across the street.

BILL MOYERS: When you stood outside the White House last week, did you really think that the leader of the free world was going to respond to a petition from a single individual, standing outside his--

DR. MARGARET FLOWERS: I--

BILL MOYERS: --his gate?

DR. MARGARET FLOWERS: --did make the point that I was representing the majority of the public and the majority of physicians.

BILL MOYERS: How could you make that claim?

DR. MARGARET FLOWERS: Because numerous polls have shown that the majority of the American public want a national health system. When the poll actually describes what it is, you know, a system where everybody pays in and everybody can get the care that they need, people desire that. They favor that. And more and more doctors-- well, we do have polls on doctors, but my experience also traveling around is the doctors support this.

BILL MOYERS: Had you taken him seriously when before his campaign, he was an advocate for single payer?

DR. MARGARET FLOWERS: I did. I even worked the polls on election day, and I knocked on doors to get people out. I guess I was naÃ¯ve. I was kind of hopeful.

BILL MOYERS: You took him seriously.

DR. MARGARET FLOWERS: Well, we knew that he understood what single payer was. In the debates, he said that he understood health care was a human right. I know that he didn't campaign on single payer or anything like it. But we felt it was an opportunity to, if we built the grassroots movement and showed that this is what the American people want, that he would actually, in some ways, include us. We saw the exact opposite. We saw that this whole process was very tightly scripted. And very exclusive. And he didn't want us causing any trouble for, you know, trying to get some reform passed.

BILL MOYERS: If the President had sent a staff person out to invite you in for coffee last week, what would you have told him?

DR. MARGARET FLOWERS: I would have told him that the American people were expecting more from him, that there's been such a huge amount of suffering in this country and preventable deaths. And that it's completely unacceptable that we are the only industrialized nation that allows this to happen. And that, it doesn't have to be this way, because we have the money. We're already spending more than any other country, so it's not an issue of whether we have the money. We have the resources to have one of the top health systems in the world. And why wasn't this debate about what is best for the people? Knowing that this is even, in terms of our economic recovery, this is vital, because our whole health system is a drag on our entire economic situation. So why is he excluding us? Why isn't he letting us be at the table, when this makes complete sense from a public policy, public health policy, economic health policy standpoint?

BILL MOYERS: What made you such a passionate advocate for single payer?

DR. MARGARET FLOWERS: Why be-- I went into medicine because I really do care about taking care of my patients and particularly, I chose pediatrics because I feel like if you give children a great start, a healthy start, they can carry that through them for the- with them through the rest of their lives and when I looked at what was going on and looked at what works in other places and what has worked here, what models have worked here, I saw that if we have a Medicare for all system, then really, doctors can practice medicine again, the art that we train to do.

BILL MOYERS: Why did you feel you weren't able to do the medicine you wanted to do, because of the health care system?

DR. MARGARET FLOWERS: Well, it started when I was working in the rural hospital where I was. And when we would admit a patient to the hospital, the first person that would come to visit us was someone from utilization review, which is the group that interfaces with the insurance company. And they would say, "You have this many days to make this patient better. This is how many days they've been authorized for." And what we often found is that didn't match the number of days that we felt the patient needed to be in the hospital. So it puts you in a really uncomfortable position of, do you send a child home before they're ready? And then in private practices it's the same kind of thing, you see a patient, you determine what's the best treatment, and then the insurance company says, â€˜No they can't have that test' or can't have that medicine. It didn't make sense. It wasn't based on what the patients need. It was based on what the insurance companies could get away with.

BILL MOYERS: Was there the eureka moment?

DR. MARGARET FLOWERS: It was a eureka moment when our office manager sat down with us in our practice and said, "Okay, if we want to keep in business, this is what you need to do. You can only see one well child a day, and the rest of the patients have to all be sick patients that you can churn through this many patients each hour." And if your patient happens to bring up something else that's bothering them, you have to ask them to reschedule and come back to talk about that other thing, which means they have to take, you know, more time off of work and continue to carry that worry with them, while they're waiting for the next appointment. That just wasn't why I went into medicine. I like the relationship that I have with patients. I want to take care of them. And when you build that relationship with your patient and you get to know them, you can provide the best care for them, not the way things are right now.

BILL MOYERS: But you know, you didn't go into medicine to get arrested. And yet there you are, on the-- out there being handcuffed and led away?

DR. MARGARET FLOWERS: Yeah, I never really dreamed that this was a path that I would go down. I mean, I'm a mother. Good citizen in my community. But it came to a point where that was the only way that we could have our voice heard. We were being completely excluded, when we tried the traditional avenues of having our voice heard. We were just put aside.

BILL MOYERS: Last May, before the Senate hearings at Max Baucus-- Senator Max Baucus were conducted, it seemed like there might be a momentum behind this single payer Medicare for all movement. What happened?

DR. MARGARET FLOWERS: They actually did start inviting us in to have a seat at the table. Senator Kennedy's committee contacted us. And I was the first person to testify in the Health Education and Labor and Pension Committee hearing. I sat next to the CEO of Aetna, which was a very interesting experience. And then when we went over to the House and spoke to the leadership there, they said, "We want your voice to be heard here." And we testified there. And so we actually thought we were starting to get our foot in the door. And then we had some amendments that were introduced that were good amendments. They would have substituted a national single payer system for the legislation that was going through, so we were really pushing on that. And then we saw that all of that fell apart.

BILL MOYERS: And then?

DR. MARGARET FLOWERS: Well, what we learned through this process is there was a lot of control coming from the White House. And they did not- they wanted to pass something. They were putting everything off on passing something in health care reform. And they were concerned that if we let the single payer voice in, or if it was associated in any way with a legislation, that it would hurt their ability to pass that legislation. So they kind of put the kibosh on it.

BILL MOYERS: The White House.

DR. MARGARET FLOWERS: Yes, it really came down from the top. We tried to bring our viewpoint in this summer. We actually brought doctors and nurses in. That was a lot of what I was doing, to meet with staffers and meet with legislators and educate them about health policy, what makes good sense from a health standpoint, not an, you know, special interest standpoint. But when we tried to reach the White House and ask to be included there, we requested meetings with the president on numerous occasions. And they just said no.

BILL MOYERS: The health reform process is broken. It's stalled, stymied. And many people think nothing is going to happen now. Do you think that's a good thing?

DR. MARGARET FLOWERS: In some ways, it is. But what we were starting to see in December, as they got close to passing the Senate version, was they were already these huge proclamations of success. You know greatest thing since Social Security and Medicare, and look how great we are for passing this. And we knew that what they were passing was designed to fail. And-- but that if it passed, it would take years for people to realize.

BILL MOYERS: The failure.

DR. MARGARET FLOWERS: Yes.

BILL MOYERS: And then--

DR. MARGARET FLOWERS: So--

BILL MOYERS: --it would be what, too late to--

DR. MARGARET FLOWERS: Well, then it would be, you know, if you look at the number of people that are dying in this country every year, and you say, "Okay, we're going to wait four or five or six years to see whether this works or not," when we already know from a health policy standpoint that it's not going to work. It's that many more people that are going to be lost during that period.

BILL MOYERS: What have you learned about our political process this last year?

DR. MARGARET FLOWERS: I didn't realize how broken it was. I knew that there were special interests influencing the process. But I didn't realize that the degree, the depth to which they're involved in our political process.

BILL MOYERS: What was the most revealing moment that told you how strong and powerful the special interests, the industries are?

DR. MARGARET FLOWERS: That was really last May, when we decided that we needed to go to the Senate Finance Committee and stand up, because we had been working for months prior to that, meeting with members of Congress who would tell us, "Yes, it makes perfect sense that we should include your proposal along with what we're putting together." We just said, "Just compare them. Compare them on universality. Compare them on cost control. Just let's have an honest debate about what's really the best." And when it came down to it, they just said, "Oh, no, we didn't really mean what we said about that. And we're not going to include you." And when we heard that they weren't going to allow us to have someone testify at that Senate Finance Committee, we just knew right then we have to do something different.

SEN. MAX BAUCUS (D-MT): The second of three roundtable discussions--

DR. MARGARET FLOWERS: Senator Baucus--

SEN. MAX BAUCUS (D-MT): --on healthcare in America. We order that we stand in recess until the police can restore order.

DR. MARGARET FLOWERS: My name is Margaret Flowers--

SEN. MAX BAUCUS (D-MT): We stand in recess until the police can restore order.

BILL MOYERS: And that was the first time you were arrested.

DR. MARGARET FLOWERS: Uh-huh.

BILL MOYERS: What was that experience like?

DR. MARGARET FLOWERS: It was terrifying. But I knew at that moment. I looked around the room, and I looked at the people who were sitting at the table, both from the senators to the people who had been invited to testify, who represented the industry. And in my mind, I juxtaposed that with the stories and the people that I've met, and the doctors I've talked to. And I felt like I was there on behalf of them. And I would do what I needed to do. And that I was ready for that.

From the Web

Dr. Margaret Flowers on Single-Payer Health Care

February 5, 2010

While many in Congress, the press and the public have given up on the idea of even a limited public option in health care reform, Flowers and her group, Physicians for a National Health Program, are standing firm for a single-payer plan. Specifically, they want to extend the Medicare program, which they see as a functioning single-payer plan, to the nation as a whole. Flowers has testified before Congress and penned Op-Eds and she has been arrested three times in her attempts to get Congress and the White House to pay attention to single-payer.

Single-Payer

The term “single-payer” generally means a system in which rather than having private, for-profit insurance companies, the government runs one large non-profit insurance organization. That organization pays all the doctor, drug and hospital bills — it is the “single-payer” of all medical bills. In most single-payer plans, every American would be enrolled and would pay into the fund through taxes.

Advocates argue that a single-payer system would pay for itself, saving huge amounts of money in administrative costs. The U.S. currently pays a higher percentage of health dollars for administration than any other nation.

Critics of single-payer plans like the American Enterprise Institute say that other nation’s single-payer plans are less than perfect in part because they aren’t forced to compete in the marketplace. “Single-payer systems do not guarantee universal access and do not necessarily result in high-quality health care. State-run systems have trouble keeping up with changes in consumer demands and new medical technology.” Other critics contend that a government-controled health care system constitutes too much government in private matters.

The U.S. also ranks highest in total cost of care, but according to a recent report by the Commonwealth Fund, ranks last among industrialized countries “in preventing deaths through use of timely and effective medical care.” In a recent Frontline report comparing the health care systems of five other capitalist democracies, “Sick Around the World,” Washington Post reporter T.R. Reid notes that, “The World Health Organization says the U.S. health care system rates 37th in the world in terms of quality and fairness. All the other rich countries do better than we do, and yet they spend a heck of a lot less.”

About Dr. Margaret Flowers

Dr. Margaret Flowers is a Maryland pediatrician with experience as a hospitalist at a rural hospital and in private practice. She is currently the Congressional Fellow of Physicians for a National Health Program, working on single-payer health care reform full time. In addition to her activity with PNHP, an organization of 17,000 doctors who support single-payer national health insurance, she is a member of Healthcare-Now! of Maryland and a co-founder of the Conversation Coalition for Health Care Reform. Dr. Flowers obtained her medical degree from the University of Maryland School of Medicine and did her residency at Johns Hopkins Hospital in Baltimore.

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